Heart disease risk factors in women

Heart disease is the number one killer of women, and
the second leading cause of death in women aged 35-64. Those frightening statistics
make heart disease quite
a hot topic these days. For women, heart disease is a multifactorial condition and
we think it’s better to know your risks. That’s because, in many cases, you can
alter your overall risk by taking action on your own.

That may sound daunting but really, it’s good news. Since information is power,
you can help protect yourself well by following an approach that minimizes as many
of these risk factors as possible. Understanding the progression of heart disease
is a good way to start, so let’s look at its early signs and the factors that contribute
to its development:

Early warning signals of heart disease: levels of cholesterol, homocysteine and
inflammation

Even as our understanding grows about the causes of cardiovascular disease, one
thing seems clear: it’s more than just cholesterol. We also know now that metabolism
and inflammation play integral roles in the development of heart disease. And it
won’t surprise you to know that other key factors include family history, age and,
as we know, gender.

Cholesterol.
Cholesterol is an essential fat-like substance that circulates through the
blood and it’s vital for building cell walls and making hormones. Cholesterol is
both consumed in food and produced by the liver, and is the foundation of hormonal
and metabolic balance. Even though cholesterol is essential, there are good and
bad types. If you have too much of the bad cholesterol and too little of the good
kind, it’s a big risk for your cardiac health.

Lipoprotein. When we talk about cholesterol levels,
we are really referring to lipoproteins or the proteins that transport and store
cholesterol complexes. Low-density lipoprotein (LDL) transports cholesterol around
your body and is considered the “bad” cholesterol. High levels of LDL can lead to
excess cholesterol deposits on artery walls. Eventually arteries narrow, or become
clogged, which reduces blood flow to the heart. That leads to heart attack or angina
and/or stroke in the brain. High-density lipoprotein (HDL) — the “good” cholesterol
— moves cholesterol out of the bloodstream and back to the liver where it is broken
down. Total cholesterol measurement is a calculation of HDL, LDL and triglycerides.
Because of this, a high cholesterol count is not necessarily bad as long as your
LDL is low and HDL is high.

How dental issues can affect heart health

Recent studies have shown that the presence of certain periodontal bacteria can
raise your risk of heart disease due to the inflammation they cause in the gums.
These bacteria pump high levels of toxins into the blood stream where they lead
to inflammation. They can then travel to other organs, including the heart and arteries,
causing localized damage. For heart health and more, see your dentist at least twice
a year.

Homocysteine. Homocysteine is an amino acid created
in your blood when you digest protein. It’s usually converted into other, less caustic
amino acids with the help of B vitamins and folic acid. If levels of vitamin B and
folic acid are low, homocysteine rises, injuring the cells that line blood vessels.
This damage leads to inflammation, which puts you at increased risk for clots and
atherosclerosis (hardening of the arteries). Other causes of high homocysteine levels
include low thyroid hormone, kidney disease, psoriasis, medications and genetic
deficiencies. Consuming essential fatty acids helps reduce localized inflammation.
Current research supports supplementing with
omega-3 fatty acids to reduce inflammation and prevent cardiovascular disease.

Insulin resistance. When your body requires higher
and higher levels of insulin for glucose metabolism, you have become insulin resistant.
This state is the precursor to type II diabetes, and is commonly seen alongside
obesity and high blood
pressure. Evidence is mounting that sustained high insulin levels are related
to chronic inflammation and subsequent cardiovascular disease. To ward off insulin
resistance, eat foods with a low-to-moderate
glycemic load, and maintain a healthy weight. Getting more
information on insulin resistance can help you make better decisions
about diet and lifestyle.

Inflammation. Chronic inflammation is a key player
in the development of heart disease and has also been linked to obesity, cancer,
type II diabetes, irritable bowel syndrome and Alzheimer’s disease. The mechanism
that drives the effects of inflammation appears to be connected to its effects on
the arteries themselves. Scientists think that inflammation destabilizes the plaques
created by high levels of LDL. When pieces of plaque break off, they encourage more
inflammation, and can lead to complete blockage of the arteries.

Decoding your blood test results

You may have noticed that your doctor no longer checks your cholesterol yearly.
New testing guidelines deemphasize “goal” levels of LDL, and now focus on accurately
assessing risk and targeting the appropriate treatment for patients at increased
risk for cardiovascular disease.

Here are some common labs your doctor may order to assess your heart disease risk:

LDL: A level of more than 130 mg/dL is considered high risk.

HDL: A level of less than 40 mg/dL is considered high risk.

Hs-CRP: High sensitivity C-reactive protein (CRP). Optimal level
is less than 1mg/L.

Hemoglobin A1C: This measures your average blood sugar over the
course of 4-8 weeks, and is used to assess for diabetes. Optimal level is less than
5.5%. A level of 5.7-6.4% indicates you may be pre-diabetic. A level of more than
7% is diagnostic of diabetes. Women who are pre-diabetic or diabetic are at significantly
increased risk of heart disease.

Homocysteine: Optimal range is 5-8 umol/L.

Most important to your overall risk is the relationship between all of these elements.
For example, if women with intermediate risk of heart disease, whether due to family
history, high LDL and low HDL, or obesity, have even slightly elevated hs-CRP in
their blood, they are at significantly higher risk of heart disease.

But heart disease isn’t just a matter of lab results. While these numbers are an
integral part of how we assess for risk and determine the best way to prevent cardiac
disease, other factors also contribute to cardiac health. This includes, believe
it or not, your emotional wellbeing.

The emotional roots of heart disease

Your heart is an organ that responds to how you feel. It jumps for joy, pounds with
anxiety, and breaks with sadness. Current research shows that people with heart
disease are more likely to suffer from depression. We think it’s connected to certain
symptoms of depression that can reduce overall physical and mental health, which
increases your risk for heart disease.

Common symptoms of depression, such as loss of interest in things you used to care
about, decreased energy and poor concentration can interfere with health, including
compliance with medication protocols. These symptoms can also drain your motivation
to care for yourself by exercising or cooking your own healthy meals. Having depression
also increases your risk of death after a heart attack.

Targeting emotional health is a new experience for most conventional doctors, but
more are coming around to it. New programs like the HeartMath System teach practitioners from all backgrounds
how to work with patients to give them tools they can use daily to help reduce stress,
channel anger constructively, and achieve emotional balance.

Your cardiovascular system may also react to unresolved emotional conflicts. Stress
and emotional difficulty feed the “flight or fight” response and if it stays activated
for long periods, you can have adrenal stress and fatigue, increased cholesterol
levels, and a weakened immune system. All leave you prone to infection and inflammation.
Because women tend to “pour their hearts out” by giving more than they receive,
many of their health concerns are traced back through their emotions to a closed
or exhausted heart. Woman may not become aware of this until entering menopause.

Menopause and the heart

The risk of heart disease increases greatly after menopause. The reasons are still
murky, but at least part of it is likely related to estrogen deficiency that changes
cardiovascular risk factors. Estrogen has been shown to have both helpful and harmful
effects on your cardiovascular health. For example, studies have shown there is
a small increase of LDL during the menopausal transition, and a possible decrease
to the protective effect of HDL. Other possible lost cardiovascular benefits linked
to a decrease in estrogen include reduced endothelial (related to the inner lining
of the blood vessels) function and decreased insulin sensitivity.

High levels of estrogen have also been demonstrated to increase cardiac risk, possibly
by increasing serum triglyceride levels and raising the risk of blood clots and
synthesis of vascular inflammatory markers such as CRP in the liver. This is why
the Women’s Health Initiative showed that both equine-based and synthetic hormone
replacement therapies (e.g. Premarin) increase heart disease risk in post-menopausal
women.

Hormones are a vital, complex part of your underlying physiology, so it’s highly
likely that they influence all of the risk factors for heart disease. How you handle
the changes during menopause will have a strong impact on your overall heart health.

Understanding the factors that affect your risk of heart disease is a good first
step — but don’t stop there. The best news is that most heart disease risk factors
are within your control. For more information about what you can do to protect yourself,
read our article on heart disease prevention.

References

World Health Organization. International statistical Classification of Diseases
and Related Health Problems, Tenth Revision (ICD-10). Geneva: World Health Organization,
1992. Available at http://www.who.int/classifications/icd/en/.